Patch test



Dec. 15, 1942. M. 5mm4 2,304,817

i PATCH TEST f Filed July 19, '1941 F/a. i

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MA URlcE GRoZ/H BY WWA@ l Patented Dec. .15, 1942 UNITED STATE s PATENTori-lee PATCH 'rlllsr Maurice Grozln, New York, N. Y.

Application July 19,

- This invention relates to patch tests.

The patch test to be discussed herein will be considered in particularrelation to its use in determining infection oi a suspect withtuberculosis.' However, the application of the test for otherpurposes-will, from the description of structures and method oi use,become obvious.

Such patch test has been found to have specic adaptability for carryingon testing in which tuberculin, or a similar medium, in varyingconcentrations, is brought into contact with the skin of a suspect. Thepatch test of this invention provides, among other things, for facilityin the observation of the reaction which then takes place, both duringthe time the reactionis going forward, and after the reaction has beencompleted.

Many different methods of testing have been Y followed ln, the past,including a technique in -which not only was the skin of the'suspectpenetrated by an instrument such as a hypoderznic needle, but, in fact,the techniquerequired that a substantial breach should be made in theskin of the suspect so that thev test ingredient might properly react.Such technique, of course, gave great pain to the suspect; if thesuspect .were

` a child,these tests have appreciable value ln mass testing in schoolsand in similar relations where large numbers of children assemble,-the

antagonismof the child became an important obstacle to be overcome.'I'he fear of the child, in many cases, has been a problem of major' Aproportions in connection with these tests.

Tests, wherein an ingredient has been applied to the skin, have beenused. However, the technique in such cases, and the apparatus availed941, serial No. 403,092 -2 claims; (el. 12s-'ci ,either in substance orin quantity, has been indicated as desirable or required. In such cases,the entire test procedure has been required to be commenced anew fromthe very beginning.

It is an object of the invention to provide a patch test wherein theprogress of the reaction may be observed at any time that the patch testis in position upon the skin of the suspect, Y

and such observation may be effected without dislocation of the locale'of the reaction, and without in any way reducing the eectivenessV ofthe test reaction.

It is an object of the invention to provide a' patch test, wherein,during the progress of the reaction, the reaction state may be observed,and the conditions of the reactions may, at the time of suchobservation, be revised under the control of the techinician and inaccordance with the indications derived from such observations.

Such change may, for instance, be eiected by a change of ingredient orits concentration.

It is an object of the invention to provide a patch test wherein,throughout the test, the locale of the reaction remains xed, but thereaction conditions may be varied at the option of the technician, sothat a number of reactions under different conditions may be observed income apparent, s o that the use of such a test of, have resultedincomplete concealment of the reaction area at al1 times throughout theentire period of reaction. To observe the reaction, the technician wasrequired roughly to estimate the time necessary for the reactionto go tocomconnection with a single xed reaction area.

It is an object of the invention to provide a patch test by the use ofwhich the technician is enabled to make his diagnosis of a condition forwhich the test is being carried on earlierv with relation to the timewhen the 'indications bemakes it possible to avoid danger of unnecessaryinalnmation which arises `in some cases from contact of the skin of thesuspect with the' test medium over too long a period.

pletion, and then allow himself a margin of error. He did not remove thereaction-concealing means until well beyond the time the re'actionshould have been completed. Then, andthen only, was he able to determinethe stage, if any, to which the reaction nrlight have progressed.

In some cases, the reaction time thus allowed by the technician mighthave been insuiilcient.

This required renewal of the test procedurai In other cases, thereaction might have gone for too long a. time. In such oase, deleteriouseffects might have: been produced, and the' technician would have beennone the wiser until he had' completely destroyedthe test means 'aslocated upon the skin of the suspect. It has not been found; feasible,in the past, to replace the test means properly in association with thetest area,

especially where a change of the ingredient,

It object of the invention to prcvide'a.l patch test wherein, because oilimitation of the area -of reaction exposed to view, by definition ofthe space within `which the reaction takes place, determination of thestate of the reaction,

at any of its stages, is made simpler. .l

Other objects of this invention will" be set forth hereinafter. .0r willbe apparent from the description and the drawing; in which arefillustrated embodiments exemplifying the invention. The invention,however, is not intended to be restricted to any particularconstruction, or any particular arrangement of parts, or any particularapplication oi' any such construction or arrangement of parts, or anyspeciiic method of operation, or any of various details thereof, hereinshown and described, as the same may be l modified in variousparticulars, or be applied in many varied relations,- Without departingfrom appear:

Fig. 1 is an elevational View of an arm having a patch test appliedthereon;

Fig. 2 is a plan view,"to enlarged scale, of the patch test shown inFig. 1;

Fig. 3 is a longitudinal cross-sectional viewA showing the manner inwhich the patch test is applied to the'arm of Fig. 1, and illustratingthe method of manipulation thereof to ascertain the intermediate statesof reaction;

Fig.'4 is a plan view of a patch test of modi# fied construction; and

Fig. 5 is a transverse cross-sectional view substantially on the'llne5--5 of Fig. 4.

.0n the drawing, a patch test P is `shown as it would'appear, applied tothe skin of the arm I0 of Aa suspect. Patch test P may be applied bymeans such as a strip I2; strip I2 may be a piece oi' material cut orformed as shown in the shape of an oblong, although such shape, or theAspecithe naps are seated within their respective openings, are incontact with the skin of the suspe, may have means appliedthereto to iixthe relationship ofthe fi'aps with relationship to the skin,A and,therefore, with relation to the walls of the openings, or to assist inso locating the ap. Such means, in o ne instance, may take the form ofan adhesive coatingon each of faces 34. 'I'he coating may, if desired,be the same type of adhesive coating generally used for adhesive tapesused in medical dressings.

'I'he test medium or media, as, for instance, tuberculin or similarsubstance, which is to be brought into juxtaposition to the skin of thearm I0 so as to, study its reaction therewith, may be -made an integeralpart of the patch test so that a particular patch test with aparticularftest medium, or with different test media. oi' variouscompositions or concentrations, may be capable iied typeof material usedfor strip l2, may not 1 be of specific importance.. In one case, stripI2 has been made from material such as used in the manufacture of thewell-known adhesive tapes used in connection. with medical` dressings,that is, a closely woven strip capable of having an adhesive face formedon one side by the application of an adhesive coating.

In the case of strip I2, shown in Fig. 2, a num ber of openings I4, I6and I8 have been formed `in .the strip. The number of openings may bedetermined'by the nature of the test or tests to be carried on, whethersimultaneous tests with the same test medium are desired, or whether itis desired to carry on simultaneously a plurality of tests with'aplurality of test media.` Openings such as openings I4, I6 ,and I8 maybe de ned in strip I2 by cutting or otherwise severing the material ofstrip I2. In the instance shown, the materialof strip I2 has beensevered just sufiiciently so asto define flaps 20, 22 and 24.lSuflilcient of the material at` each flap is left un` severed so that,while the flaps 'are free to move out of openings I4, I6 and I8 touncover the skin areas defined by the openings, and to be moved into andtofill the openings, still the iiaps remain secured to the main body 26of the material of strip I2, merely hinging'upon the respective sections28, 30 and 32, respectively; connectingtheiiapstomainbodyl.

The material from which strip I2 is formed is of sufiicient thickness togivebody to the flaps,

and also to assure that, when the ilaps are hinged to move intoposition'within openings I4, I6 and" Il, the aps will beretainedsecurely in position by engagement of the edge walls of flaps] 2022 and24 with the walls of openings I4, I6 and I8, respectively.

Faces 34 of flaps 20, 22 and 24 which, when "of the reaction.

of being supplied. In such case, the particular medium or media, in theproperconcentration,

is applied in any desired manner' to face 34 of the respective flaps 20,22 and 24. The method of, incorporation of the test medium with Afacedium, and then the impregnated material may' have been cut up into smallsections. If face 34 of the flaps has had a coating of adhesive materialapplied thereto, one of these sections 36 may be adhered to face 34. Insuch case, section 36 desirably will be lessin extent than the eiectivearea of the flap to permit the flap to present to the skin of thesuspect at least substantial perimetric portions of adhesive-coated`4surface to engage the skin for holding the flap Also the test of asolution of the active ingredient, and have been dropped upon thecoating of face 34, and

then permittedto dry into the coating.

After strip I2 has been located on thejskin ofthe suspect, the reactionmay be observed at,

any time the technician desires merely by lifting the iiap out of itsrespective opening. The skin at such location is thus exposed and iscapable of thoroughl inspection to determine the state After the`technician has completed his observation, he merely bendsand pushes theilap back into po ition, sealing the opening, and bringing the a and thetestcmedium again into contact with the skin so that the reaction maythen continue.

In order to afford 'a control withl which the reactions at the diierentareas may be checked. the test medium may be omitted from onel of theskin areas covered by .Ja flap, or an ingredient which is wholly withoutreactive eiect upon the skinof a suspect may be applied to the ap ormayotherwise be brought into conjunction with `the skin of one area.Thus, by lifting the ilap atan area at which al positive .test medium,is present and the ap at an area where the neutral ingredient iseffective, the true and relative condition of the reaction upon the skinof the test medium may be studiedldirectly.

In order to assure that strip I2 adhere to the "skin as a. whole,portions of the strip, at

face 38, which are not included' in a flap, may have a coating of anadhesive substance applied thereto. This adhesive substance may be thesame as -or similar to the adhesive used upon face 34. y f

On Fig. 4, patchv test`40 of modified construction is shown. Patch test40 may comprisev a strip 42 of material through which a plurality ofopenings 44, 46 and 48 extend. Strip 42 may be applied to and beretained in position upon the skin of the arm substantially in the sameway as indicated for strip l2. No flaps are provided.

at openings 44, 46, and 48.

Patches 50, 52 and 54 are provided, and are ingredient which will bewhollywithout effect upon the skin of a suspect, in the same manner asone of the flaps, say iiap 22, was so provided.

Patches 50, 52 and 54'may have an adhesive vcoating upon their faces 56which are, at least in part and at openings 44, 46 and 48', brought intocontact with the skin. This adhesive conl 1 tact serves, in addition tothe adhesive action of strip 42 itself, to anchor strip 42 in-position,and thus fixedly to locate the reaction areas vdefined by openings 44,46 and-48. 1

Patches su, s2 and 54 are shown 'as positioned' on strip 42 to extendtransversely of vthe width of strip 42. Patches 50, 52 and 54 may beslightly longer than the width of strip 42'so that portions of thesestrips-will bend over the edges of strip 42, and adhesively attachthemselves to the skin of the suspect. Simply byl lifting any one ofpatches 50, 52 and. 54 to disengage it from its engagement with the skinof the suspect, and then to free it from its covering relation over -therespective opening, is all thatis necessary to permit inspection of thereaction area at the selected opening. Strip 42' is in n`o way affectednor'is the reaction area in any way changed. After the inspection, theparticular patch is pushed back into position, so that the reactionmaycontinue as before, without change or disturbance ,of the reaction area.v

Thus, in either of these cases, theprogress of the reaction may bevdetermined atany time. Immediately that such observation discloses thepresence of. the condition for which the testis being made, the patchtest may be removed from .the arm. If, however, no such positivereaction has appeared, the technician, if he so desires, may change thetest medium at that particular reaction'area. For instance, in the caseof test for tuberculin may be added to the reaction area through theopening, and then the 4opening -may be closed by means of a flap orapatch, according to which patch. test is used.' For instance', such'change may be 'either a change of concentration, or a' change ofingredient. In either case, without changing `the location o f the patchtest, the change can be effected .by depositing a drop of the testmedium upon skin, flap or patch, and then returning flap or patch intoits reaction position.

- similar test ingredient applied thereto, a iiap" progress of thereactionfis thus possible,`and the reaction may be terminated as soon asany positive indication appears.

Information regarding the particular ingredient upon a particular fiapor upon a particular test patch may be imprinted, in'theform of indicia51, upon face 58 of the flap or upon face 60 of the patch. For instance,the lpatches may be supplied separately from strip 42, in which casesuch identification would be of material importance.

Many other changes could be effected in the particular apparatusdesigned, and in methods of operation and use set forth, and in specificdetails thereof, without substantially departing from the inventionintended to be defined in the claims, the specific 'description beingmerely of exemplifying embodiments in accordance with the statutes.

What is claimed as new and useful is:

1. A patch test for use in determining the pathological reaction of ahuman body to tuberculin and similar substances, the test includingi astrip of substantially flexible material, the strip having means on oneface for adhesively retaining the-strip in position upon and in a fixedrelation to a portion of the skin of the body, the strip having aplurality of openings therethrough at spaced apart positions, sectionsof the strip being partially severed from the strip to define theopenings and to form flap sections including the adhesive means, each`flap section being capable of movement relative to the strip intocontact with the skin of the body to close its opening and to beretained in engagement with the skin at the opening or away from theskin of the body to permit inspection of the skin through its opening,

the flap sections remaining engaged with'the strip so as not to'becomeseparated therefrom, one or more of' the nap sections having tuberculinor section having the ingredient applied thereto being movablerelatively to the strip without disturbance of the relation ofassociation of the strip to the respective openingpg. v g, e

2. A patch test '.fo use in determining the pathological reaction of ahuman body to tuberculin and similar substances, the test including astrip of substantially flexible. material, the strip having means on oneface for adhesively retaining the strip in a fixed relation to a portionof the skin of .the..body, the strip having an opening tuberculosis, adrop or similar quantity of' therethrough, a section of thestrip beingpartially severed from the strip to dene the openingr and to form afiapsection including the adhesive means, the flap section being'capable of movement relative to the strip into contact with ,the

Y skin of the body to `close the opening and to be It'should beunderstood that, under certain conl 'in plac' g the patch test in actionat the very beginning'of such a reaction. Observation ofthe retained inengagement with ythe skin at the opening or away from the body to allowinspection' of the bodythrough the opening, the flap section remainingengaged with the material'of the'strip so as not to become separatedtherefrom, the flapl section having tuberculin' or similar testingredient applied thereto, the flap4 section, when not moved away'fromthe strip, lbeing in position to hmaintain the ingredient in contactwith the skin at the openingftheap -sectionbeing movable relatively tothe strip to permit inspection oi' the' skin at the opening withoutdisturbance of the lassociated relationship-'of the strip and the skinat the opening. l

' Y v MAURICE GROZIN.

